Physician Communications: Considerations for Using Text Messages and Social Media

It is becoming easier and easier for physicians to communicate with each other and their patients. And although open communication is generally thought of as positive, the medical profession should proceed with caution. Patients and consulting physicians rely heavily on their communications with their treating physicians. Thus, communications which do not require the thought of focus that a physician would otherwise give to a situation may result in disaster. While there are many potential ways a physician might use text messaging and social media both professionally and personally, we will focus generally on physician interactions with other physicians, and physician interactions with patients.

To start, physicians should be aware that, in 2011, the American Medical Association issued guidelines in its Code of Ethics for physicians who use social media:

Physicians should safeguard patient privacy and confidentiality online, and via text message, and must refrain from posting identifiable patient information;

Physicians should realize that privacy settings are not absolute and that once on the Internet, content is likely there permanently.

If they interact with patients on the Internet, physicians must maintain the same professional and ethical boundaries as they would in any other context.

Physicians are strongly urged to separate personal and professional content online.

Physicians should defend the profession, and should act in the event that unprofessional or unethical content posted by colleagues.

Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers, and can undermine public trust in the medical profession.

Interactions with Other Physicians

Connecting with other physicians using social media is a great way to share information and improve the profession. However, most times text messaging and using social media to work with other physicians is not appropriate.

Messages between physicians for the purpose of treating an individual must be timely and adequately documented in the patient’s medical record. At this point in time, that is terribly difficult to accomplish successfully and consistently.

There are at least a few popular social media platforms that are exclusive only to physicians. Certain of those say that they allow anonymous postings and interactions. However, physicians must realize that hardly anything on the internet is actually anonymous. Physicians must be sure to uphold the ethics and obligations of the practice of medicine when posting anything on any site, whether or not their names are readily available. HIPAA does not subside just because a physician’s name is not directly connected to a posting. Nor does it subside because a patient’s name is not mentioned in a posting.

A good practice is for a physician is to step away from the posting or text message prior to sending it, to consider what purpose it will serve, and to consider whether it preserves the confidentiality and ethical obligations that are necessary for the situation.

Moreover, physician interactions with other physicians on purely social media, especially their superiors at work, may blur the lines between professional and personal lives. Supervisor physicians (employers, attendings, professors, etc.) should not attempt to connect with their subordinates via social media and subordinate physicians should think twice before asking to connect with supervisor physicians.

Interactions with Patients

First and foremost, before any interaction with a patient using social media, text messaging, video conferencing or some similar transmission, physicians must adhere to any and all applicable telemedicine statutes in the states where they practice. Telemedicine laws are constantly evolving to keep up with changes in the area of communications, and physicians are well-served to acquaint themselves with the laws.

The AMA Code of Medical Ethics contains an opinion for the use of electronic mail in communicating with a patient. Perhaps most importantly, the Code sets forth that e-mail correspondence should supplement a physician’s personal encounters with a patient. Moreover, a physician is held to the same professional and ethical standards over email that he/she is held to in person. Medical advice or patient-specific information should not be transmitted over an unsecure connection and without the patient’s prior authorization.

Although the AMA has not put out guidance regarding text message communications with patients, physicians are advised to consider using the same guidelines. For example, text messages containing patient-specific data should not be provided over an unsecure or public connection. Copies of the text message should be saved to a patient’s file to ensure continuity of care. And physicians must realize they are held to the same standard of care over text messages that they are in their office encounters. A one-off text message rendered without a full picture could subject the physician to just as much liability as an inaccurate assessment made in-office. The adequacy of care cannot be sacrificed for the sake of ease in communication.

Messages sent to patients over social media are even more problematic. Patient privacy laws generally precludes providing patient-specific information this way. Moreover, even if patient-specific information is not transmitted via social media, a physician’s failure to maintain proper professional boundaries with his/her patients may tarnish the reputation of the profession and subject the physician to discipline